An updated report from the American Academy of Pediatrics reviews the role of the pediatrician in the clinical steps prior to anesthesia use in pediatric surgery, as well as the importance of ensuring that both the patient and the family are emotionally and cognitively prepared to face what is often a traumatic moment.

The report emphasizes that pediatricians play a key role in preparing patients and their families for anesthesia and surgery by addressing two main areas of concern:

The primary care pediatrician is an important part of what must be a collaborative, team‑based effort, as they are uniquely positioned to address the needs of the pediatric patient by age, size, and stage of development, as well as the family's concerns when anesthesia or sedation is being considered.

The existing relationship between the child and their healthcare provider, as well as the provider’s relationship with the family, is highly valuable.

Therefore, effective communication and collaboration among the pediatrician, the surgical team, and the anesthesiologist or sedation specialist are essential to providing the smoothest, least traumatic experience possible for both the patient and their parents or guardians.

This report describes tasks prior to scheduled (non‑emergency) surgical procedures, including:

Each year, nearly 4 million surgical procedures are performed on children and adolescents in the United States. Pediatric patients receive anesthesia or sedation for a wide range of procedures and operations.

These patients often have complex coexisting conditions or undergo extensive or complicated surgeries that require addressing their medical conditions and optimizing their health status before receiving anesthesia or sedation.

The Latin American Study of Surgical Outcomes in Pediatric Patients highlights the need to determine the significance of complications in pediatric surgical patients in Latin America, as well as the risk factors and types of complications they experience, given the limited data available on this population.

The perioperative period can be stressful and anxiety‑provoking for pediatric patients and their families. The pediatrician is in a unique position to help meet the developmental needs of children and adolescents when procedures requiring anesthesia or sedation are being considered.

Excellent communication among all healthcare providers can improve outcomes and ensure the safest and least disruptive experience for the patient.

Preparing a child or adolescent physically for anesthesia requires understanding any prior or current conditions that may affect anesthesia administration. Ideally, both the anesthesiologist and the pediatrician will have access to the patient’s medical history, and both perspectives are important in planning anesthesia.

Parents or guardians come to the encounter with their own experiences, based on prior situations or natural parental concerns. Their perspectives may differ significantly from the child's.

The pediatrician’s role is not to “clear” the patient for surgery, but rather to help optimize their health before undergoing anesthesia or surgery and to confirm that there are no contraindications for the planned procedures at that time. The anesthesiologist will also review the medical history, examine the patient, and make a final determination of the risks and benefits of the procedure on the day of surgery.

Sequential, bidirectional communication between the pediatrician and the anesthesiologist incorporates the pediatric perspective into perioperative planning.

Typically, the surgeon notifies the pediatrician about the planned procedure and requests that the patient be evaluated in advance. For elective procedures, this notification should occur early enough for the pediatrician to complete the pre‑anesthesia evaluation and communicate relevant findings, along with specific concerns about acute or chronic factors, to both the surgeon and the anesthesiologist.

This advanced notice allows for additional consultations if necessary and optimal planning of the procedure.

The primary care provider may have access to medical records that the anesthesia team does not. Particularly relevant information before surgery includes:

Allergies to medications, latex, betadine, or chlorhexidine may affect surgical preparation. Also useful for preoperative planning are physical limitations, dependence on medical technology (tracheostomy, ventilatory support, feeding tube), nutritional status, and positioning considerations. A history of difficulty obtaining peripheral venous access is also important.

Safe perioperative care of children is complex and requires equipment and resources specifically suited to pediatric patients, as well as personnel with specialized training and skills in the care of infants and children, according to a report based on recommendations from the American Academy of Pediatrics, which also analyzes these procedures in neonates.

The patient’s developmental level and intellectual function can affect anesthesia planning, especially during the stressful period from arrival at the medical facility to anesthesia induction.

Parents’ or guardians’ reactions to their child's stress during a procedure can also influence the anesthesia team’s interactions with the child or adolescent and the parents or guardians.

Children and adolescents with neurodevelopmental disorders, such as autism spectrum disorder, intellectual disability, sensory sensitivities, or mental health conditions—including anxiety—may present greater management challenges, especially when facing unfamiliar environments and providers or perceiving caregiver anxiety.

Families or primary caregivers are the best source of information on how to keep the child calm and cooperative.

Many underlying mental health conditions may worsen due to stress and anxiety related to anesthesia. In some cases, healthcare professionals may need to use sedation to keep the patient calm.

Flexibility among staff and effective communication are of utmost importance.

Early involvement of child life specialists or mental health professionals can be very helpful in developing a preparation plan for the patient and family.